Document Detail


Multiple-birth infants at higher risk for development of deformational plagiocephaly: II. is one twin at greater risk?
MedLine Citation:
PMID:  11773537     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In part 1 of this investigation, we demonstrated that children of multiple birth pregnancies are at higher risk for development of deformational plagiocephaly. In the current investigation, we explore whether certain prenatal and postnatal risk factors predispose one twin over the other by examining the occurrence and severity of plagiocephaly in both discordant (only 1 affected) and concordant (both affected) twin pairs. METHODS: Throughout 1999, we obtained detailed medical histories on 140 sets of twins who had presented for treatment at 1 of 9 treatment centers across the United States. The study cohort consisted of 46 concordant and 94 discordant twin pairs (a total of 280 study participants). Information about prenatal and postnatal history of each infant was obtained through detailed review of the children's medical records as well as analysis of a patient database maintained on all infants who receive treatment. Follow-up interviews were performed to verify the information recorded and to obtain additional information about the child who had not received treatment (if appropriate) or use of reproductive assistance (fertility drugs, intracytoplasmic sperm injection, etc) that had not been previously recorded. Statistical analyses were performed to assess the effects of prenatal and postnatal risk factors (in utero position, in utero orientation, birth weight, neck involvement, sleeping position) with respect to which infant was affected in the discordant twin pairs and to which infant was more severely affected in the concordant twin pairs. RESULTS: Statistical analyses of both discordant and concordant twin pairs demonstrated that the lower in utero infant was significantly more likely to be affected (chi(2) = 17.391). In addition, the more severely affected infant was significantly more likely to have some form of neck involvement (torticollis, neck tightness; chi(2) = 46.380), as well as have been carried in a vertex position (chi(2) = 7.408). Conversely, neither sleeping position nor gender was found to be associated with development of plagiocephaly. CONCLUSIONS: The results of this investigation strongly support an in utero cause of plagiocephaly and demonstrate that intrauterine positioning may play a prominent role in determining both the occurrence and severity of deformational plagiocephaly in twins. These findings confirm that the lower in utero infant is at increased risk for the development of plagiocephaly, likely resulting from the more restrictive intrauterine environment encountered during the later part of the pregnancy.
Authors:
Timothy R Littlefield; Kevin M Kelly; Jeanne K Pomatto; Stephen P Beals
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics     Volume:  109     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-01-04     Completed Date:  2002-02-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  19-25     Citation Subset:  AIM; IM    
Affiliation:
Cranial Technologies, Inc, Phoenix, Arizona. littlefi@cranialtech.com
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MeSH Terms
Descriptor/Qualifier:
Abnormalities, Multiple / epidemiology
Adult
Comorbidity
Cranial Sutures / abnormalities*
Diseases in Twins / epidemiology*
Facial Asymmetry / epidemiology
Female
Humans
Incidence
Infant
Infant, Newborn
Infant, Premature, Diseases / epidemiology
Labor Presentation
Male
Pregnancy
Risk Assessment
Sex Distribution
Torticollis / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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